Second Opinions Blog

The industry's top independent medical evaluation service provider offers timely information on a wide range of medical news and claims management topics - all in the name of helping you manage injury claims in the most efficient and cost effective manner.

The thoracic spine runs from just below our neck down to just above our low back; it is our middle back. It is what anchors our rib cage. The rib cage along with the spine protects the internal organs located in the torso. When the thoracic spine is injured, it has an effect on other organs in your body.

The nerves of T1-T5 affect muscles of the upper chest, mid-back and abdomen which control the rib cage, lungs, diaphragm and the muscles that control breathing. Injuries to T1-T5 usually affect the abdominal and lower back muscles and legs, typically resulting in paraplegia. Arm and hand function usually remains normal.

T6-T12 nerves affect abdominal and back muscles. These are important for balance and posture, and they help you cough or expel foreign matter from the airway. Injury to T6-T12 usually results in paraplegia with little or no voluntary control of bowel or bladder.

Vertebrae Injured

Can Cause Issues With

T1

Hands and fingers

T1-T4

Esophagus

Trachea

Lungs (congestion, bronchitis, or difficulty breathing/swallowing)

T2-T5

Chest muscles

Liver

Blood Pressure

Poor Circulation

T6-T8

Chest and abdominal muscles

Pancreas

Stomach

Spleen

T9-T12

Abdominal muscles

Lower Thoracic Vertebrae

Kidney

Small Intestine

The prognosis and recovery from thoracic injuries differs from person to person based on the type of injury and level of severity. General overall health is also an important factor in determining level of independence achieved after injury.

Lateral lumbar interbody fusion (XLIF) is a minimally invasive option to lumbar surgery. This procedure is done from the side rather than the front or back resulting in reduced time for operation, fewer recovery days, minimal scarring, reduced blood loss, less post-operative pain, and quicker return to daily activities. It is an outpatient procedure which is not appropriate in every situation.

This procedure is performed with one or more tiny incisions and a medical device called a retractor that’s used to spread apart overlying tissue to give the doctor a clear view of the spine. The retractor and dilator system used in the lateral lumbar interbody fusion is called MaXcess™ which allows the surgeon to reach the spine via a lateral view from the side with minimal muscle and ligament tampering and no disruption to abdominal muscles.

The recovery process is quicker than with traditional surgery. The patient can get up and walk immediately following the procedure, minor pain afterwards, and the results are immediately apparent rather than having to wait for a gradual return to normalcy as in the traditional fusion surgery.

Over 400 published clinical studies support the procedure, documenting positive clinical outcomes as comparted to traditional posterior fusion procedures.

The thoracic spine contains 50% of the spines joints and is responsible for two-thirds of the movement in your torso. It is important to take good care of the thoracic spine in particular so you can maintain mobility and avoid a stiff rib cage which can restrict the capacity of your diaphragm and lungs.

You can test your own range of motion using the yoga gesture of Uddiyana Bandha (Upward Abdominal Lock). The best time to do it is early in the morning with an empty stomach and bowls. If you have any health conditions such as high blood pressure, hiatal hernia, ulcers, pregnancy, or menstruation, check with your doctor first. Here’s how it’s done:

Exhale completely. Notice that you do this pressing in with both your chest and abdomen. You can pretend to be blowing up a balloon as much as possible with one breath.

Do a mock inhalation using your chest, locking your glottis and restraining air from entering your lungs, and at the same time relax your abdomen. If you get confused about how to prevent air from entering your lungs, you can try to inhale (without inhaling) while blocking your mouth and nose with your hands. You should feel your chest lift.

Press gently in with your chest and abdomen, thus equalizing air pressure on the inside and outside of the body, and gently inhale without gasping.

This exercise challenges your thoracic spine and rib cage to use their full range of motion at the costovertebral joints, taking the ribs to their most elevated state which causes the diaphragm to stretch laterally. When done regularly and correctly, it also keeps your thoracic spine healthy.

Spinal cord injuries are devastating. In the U.S. there are approximately 12,000 spinal cord injuries every year in which the injured person survives the initial accident. For those who survive the initial accident, the road forward is physically demanding, psychologically taxing, and financially burdensome. A spinal cord injury patient can expect to spend well over a month in hospitals and in-patient rehabilitation (sometimes considerably longer depending on the severity of the injury and whether there are simultaneous cognitive impairments or other comorbidities). In addition, the lifetime costs of spinal cord injuries are extensive, having a present day value ranging from $4,540,000 for a 20-year-old patient with high tetraplegia (spinal cord injury at C1-C4) to $1,460,000 for a 60-year-old patient with paraplegia. The occupational effects are profound, with only 35% of spinal cord injury patients able to achieve a similar pre-injury level of employment 20 years post-injury. Obviously, the costs of spinal cord injury claims are enormous and usually lifelong. Since the two most common causes of spinal cord injuries are motor vehicle crashes and falls, liability claims are relatively common when spinal cord injuries occur.

Certainly no one did more to raise awareness of spinal cord injuries than Christopher Reeve, who suffered a spinal cord injury causing high tetraplegia (C1-C2) after falling from a horse in 1995. Periodically high profile athletes suffer spinal cord injuries that thrust the issue back into the national spotlight. In 2010, Rutgers football player Eric LeGrande sustained a spinal cord injury during a game that initially left him paralyzed from the neck down. In October 1995, Travis Roy was just 11 seconds into his first shift in his first game as a hockey player for Boston University when he crashed head-first into the boards and suffered a spinal cord injury that also paralyzed him from the neck down.

More recently, Olympic swimmer and multiple gold medal-winning swimmer Amy Van Dyken suffered a spinal cord injury away from athletics in June 2014 when she fell off the all-terrain vehicle she was driving and down a 5-7 foot embankment. The accident injured her spinal cord at T11 and left her paralyzed from the waist down.

These famous athletes and celebrities periodically remind us of both the risk and devastating consequences of spinal cord injury. Fortunately, progress is being made in managing the post-injury effects of spinal cord injury. The most frequently reported-on developments typically involve bionic exoskeletons that help the paralyzed person move their limbs. However, recently medical researchers have been making strides in using electrical stimulation to allow the injured patient voluntarily move paralyzed limbs. In recently reported research, external electrodes were placed over 5 patients’ spinal columns who have suffered from paraplegia for at least two years. The electrodes in combination with the drug Buspirone allowed the patients to move their limbs under stimulation, which was not unexpected. What was remarkable is that the patients retained the ability to move their legs even without electrical stimulation after 4 weeks of treatment. As lead researcher Prof. V. Reggie Edgerton noted, "The fact that they regained voluntary control so quickly must mean that they had neural connections that were dormant, which we reawakened." The findings are considered remarkable because the medical and scientific community had accepted that persons with complete paralysis “no longer had any neural connections in the spinal area” suggesting that it may be possible to regain motor function without regenerating spinal neurons or using an exoskeleton system.

This research along with the mind-boggling progress that is being made with patient-controlled exoskeleton devices is changing the landscape for spinal cord injury patients. These developments are welcome news for patients, their families, and society alike. As noted above, the occupational and medical costs of spinal cord injuries are enormous. Anything that can return function to patients has the potential to minimize the occupational impact and long-term medical expenses of spinal cord injuries, which is good news for civil liability systems as well. Spinal cord injuries are among the most costly injuries to everyone involved. Improving outcomes in spinal cord injuries will benefit an extraordinary number of individual lives and also the institutions set up to absorb the costs.

There are only so many hours in a day and giving each file the attention it deserves takes time. So, how do you squeeze more hours out of every day? That’s easy – increase efficiency, and you will increase productivity! Here are a few tips to help you effectively manage your time:

Get Organized – Keep a neat work area. Get rid of what you don’t need on your desk. Place important documents in labeled folders and group the folders by claim number in easily accessible, secure file drawers. Keep your emails organized by creating a folder for each file and putting all email correspondence in the appropriate file.

Create a Plan – Create a master task plan (or checklist) for each file you are working on. Each task should be in priority order with deadlines clearly visible. There are many types of project management software designed to help you keep track of tasks and deadlines.

Use a To Do List – Every morning, review the master task plan for each file (observing any deadlines) and make a list of tasks that need to be completed that day.

Adding these simple steps to your daily routine can help you stay on task and on schedule and improve productivity so you can identify and resolve problems more quickly. Good project management skills improve work-quality, increasing customer satisfaction and giving you the competitive advantage needed to boost your bottom line.

The thoracic spine (located between the cervical and lumbar spines) is your middle back, beginning right below your neck and ending at your low back. The main function of the thoracic spine is to anchor the rib cage and protect the spinal cord, heart and lungs. It is the longest and most complex region of the spine; made up of 12 vertebral bodies that hold disks (T1-T12). T1 connects with the cervical spine above at C7 and T12 with the lumbar spine below at L1.

Interestingly, the space between disks (intervertebral opening) is much larger in the thoracic spine as compared to both the cervical and lumbar spines. A bigger intervertebral opening and smaller nerve root allows more room for spinal nerves and reduces the chance of the nerve becoming pinched or inflamed. Recent research suggests this might be the reason disk degeneration of the thoracic spine is much less likely to cause pain or other symptoms, unless of course the degeneration causes a disk to push on a nerve. There are several other causes of thoracic spine pain.

Myofascial pain (muscular in nature) can be caused by poor posture, or any irritation of the large back or shoulder muscles, which would include strains or spasms. Joint dysfunction, thoracic herniated disk, compression fracture, kyphosis, scoliosis, arthritis or osteoporosis can also cause pain.

Symptoms of nerve damage in the thoracic spine include:

Stooped posture

Muscle weakness/spasms

Pain that is referred to the ribs, shoulder, arm, fingers, neck or legs

Whiplash is not really a medical condition. It is a term used to describe the sudden acceleration-deceleration mechanism of injury to the neck. A whiplash injury can range from a muscle sprain to spinal cord contusions to fractured vertebra. Spinal cord contusions and fractured vertebra can be easily detected, but a muscle sprain cannot. This means there is no way to prove or disprove most claims of whiplash injury where a muscle sprain is involved.

While a car accident victim can experience neck, head, and back pain following the accident, but can such an energy transfer cause chronic, long-lasting pain, and if so, how?

There is no proven physical reason why a whiplash injury would cause chronic pain. But, in fact, about 25% of whiplash injury patients suffer chronic pain. Additionally, whiplash injuries in the United States come with a price tag of about 2.7 billion dollars a year1. So, what we know about whiplash is important to lowering claim costs.

A concussion is the most common and least serious type of traumatic brain injury. The brain is the consistency of gelatin and is cushioned by cerebrospinal fluid inside the skull. A violent bump, blow or jolt to the head, neck or upper body can cause the brain to slide back and forth forcefully against the inner walls of the skull, or twist in the skull which can create a bruise on the brain. A concussion can sometimes create chemical changes in the brain, even stretching or damaging brain cells. A concussion is a traumatic brain injury that affects brain function and should be taken seriously.

Typically, a concussion is diagnosed through a physical exam and interview. The doctor will begin with questions about how the injury happened and its symptoms. A physical examination may follow to determine what symptoms. Some doctors use a special eye test to look for concussions. It assesses if any visual changes are related to concussion such as changes in pupil size, eye movements and light sensitivities. If there is a question of bruising or bleeding in the brain, an MRI or CT may be ordered. If there are seizures, an electroencephalogram (which monitors brain waves) may be performed.

Most concussions don’t require surgery or any major medical treatment; they are symptomatically treated. For example, over-the-counter pain relievers may be recommended for headaches. Rest, avoiding sports and other strenuous activities is also recommended. Driving a motor vehicle or bike should be avoided for 24 hours or longer. Consuming alcohol may slow recovery.

Concussions are usually not life-threatening but can cause serious symptoms requiring medical treatment. Symptoms include some or all of the following:

Headache or feeling of pressure in the head

Temporary loss of consciousness

Dizziness or “seeing stars”

Ringing in ears

Nausea

Confusion or feeling “in a fog”

Amnesia with regard to the traumatic event

Slurred speech

Appearing dazed

Vomiting

Fatigue

Delayed response to questions

Sleep disturbances

Disorders of taste and smell

Psychological adjustment problems and depression

Concentration and memory complaints

Irritability and other personality changes

Sensitivity to light and noise

Loss of consciousness lasting longer than 30 seconds

Headache worsening over time

Changes in physical coordination, such as stumbling or clumsiness

Confusion or disorientation, such as difficulty recognizing people or places

Seizures

Vision or eye disturbances

With more severe concussions, these symptoms may be more severe or worsen with time. Repeated concussions can cause problems such as lasting cognitive issues.

Rehabilitation is an important part of the recovery process for a TBI patient. The program should be customized to the person based on their strengths and capacities and modified over time to adapt to changing needs. This usually involves a team of rehabilitation specialists in multi-specialties. Individually tailored programs generally include physical therapy, occupational therapy, speech/language therapy, physiatry, psychology/psychiatry, and social support. There are several options for rehabilitation: home-based, hospital outpatient, hospital inpatient, comprehensive day programs, supportive living programs, independent living centers, club-house programs, school based programs for kids and others.

The overall goal is to improve the patient’s ability to function at home, work and in society. This is done through helping the patient adapt to disabilities or to modify their environment to make every day activities easier. Medications must be carefully prescribed because TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents. It is also important for family members to provide support for the TBI patient through involvement in their rehabilitation program.

TBI recovery is slow, with a step-by-step course which progresses from coma, vegetative state, minimally conscious, conscious and then to a post-traumatic confusional state. The severity of a TBI cannot be determined in the first few days after injury it may take weeks – or even months – to determine how or if a person will recover over time. Many persons will eventually regain consciousness, but some will not.

Often improvement continues slowly over time. There is much variation of how people move through each stage and how long each stage lasts. Some people move quickly or skip stages while others may get stuck in a stage. Every injury is different and follows its own timeline. The longer a person remains in a coma or state of impaired consciousness, generally the more likely they will be severely disabled.

One of the first meaningful behaviors a severely brain-injured person shows is the ability to follow an object with their eyes (visual tracking), is a definite sign of moving toward consciousness. The earlier a person moves from a coma or vegetative state to a minimally conscious state, the better the long-term outcome. Even if the disorder of consciousness lasts for several months, improvement can still be shown. In this case specialized TBI rehabilitation may be beneficial.

Age plays a role in recovery outcome. Younger people are more likely to return to a more independent, productive life. Older persons don’t usually fair as well. However, an accurate diagnosis of level of consciousness is imperative because it helps predict the short and long term outcomes. This helps in making decisions concerning rehabilitation or whether to stop care altogether.